"Hop up on the table, Honey."
Donna W. Hill
September 06, 2009
"Hop up on the table, Honey."
That's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't.
This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system.
We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year—almost $8,000 per person."
That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and those who think they are covered. Conditions flagged for refusal to insure, premium increases or for "re-evaluating" (discontinuing) coverage, which used to be limited to the most debilitating disorders, now include diabetes and asthma – two of America's fastest rising diseases.
Cutting costs, providing coverage for the uninsured and guarantying that coverage cannot be refused based on diagnosis or denied because of pre-existing conditions, are essential goals. These, however, will not be sufficient to fix the system.
By every major measure of healthcare and wellness, from infant mortality to longevity, the United States lags behind other developed nations. In 2008, the Centers for Disease Control (CDC) rated the US as 29th in infant mortality. The longest-lived people on the planet live in Andorra, San Marino, Singapore and Japan. Austria, Australia, Canada, France, Germany, Greece, Israel and Italy are just some of the countries where people live longer than the U.S. average -- seventy-eight years.
The World Health Organization conducted the first analysis of the world's health systems in 2000. They found that, although the US spends the highest portion of its gross domestic product (GDP) on healthcare, it ranks only thirty-seventh out of 191 nations. France and Italy provide the best overall healthcare. San Marino, Andorra, Malta and Singapore are right behind Italy, followed by Spain, Oman, Austria and Japan. The United Kingdom, which spends only six percent of GDP on healthcare, is eighteenth.
The problem is complicated. For one thing, profound flaws in the basic education of healthcare professionals are contributing to many medical errors, especially in diagnosing and treating elderly patients. In her article "The Patients Doctors Don't Know" (July 2, 2009, The New York Times), Dr. Rosanne M. Leipzig, a physician and professor at Mt. Sinai School of Medicine, explains that experience in geriatric care, unlike pediatrics and obstetrics, is not required for medical school graduates. This oversight persists despite the fact that physicians have long since been far more likely to have elderly patients, a situation which is increasing as the population ages.
Conditions like heart attacks and pneumonia, which present different symptoms in the elderly, are often misdiagnosed. The resulting improper treatment makes these patients more likely to need further care, escalating healthcare costs. The 2008 Institute of Medicine (IOM) report "Retooling for an Aging America" makes significant recommendations on the subject, but as Leipzig writes, "this resolution lacks teeth,".
"Medical resident training programs that receive Medicare money," Dr. Leipzig continues, "should be required to demonstrate that their trainees are competent in geriatric care."
What a concept.
After the Ink Dries: The Impact of Paperwork on Healthcare
Paperwork is another huge contributor to the healthcare problem. Handwritten prescriptions and doctor's orders cause countless adverse reactions, in addition to improper and neglected treatment. What about the cost in dollars as well as undelivered care for the time wasted when conscientious medical professionals, who realize they aren't sure what is written, stop what they are doing to find out?
Legibility is just one issue. A consequence of the enormous number of prescription drugs is that medications for different conditions have similar names. In 2005, one death in Boston was attributed to giving a huge dose of Librium to a patient instead of the prescribed Lithium. Toprol (a beta blocker prescribed for high blood pressure, chest pain and heart failure) and Topamax (used to treat epilepsy and prevent migraines) have also been confused, causing adverse reactions. Similarities in packaging for child and adult doses of certain medications have led to life-threatening situations. The most publicized of these involved the twelve-day-old twins of actor Dennis Quaid, who, in 2007, received a dose of heparin a thousand times stronger than prescribed.
Pharmacists and nurses must exercise extreme care to get it right. Nonetheless, my husband once witnessed a nurse preparing tiny cups of evening meds for her entire wing while on her cell phone. What could go wrong there?
The management of patient records, which President Obama to his credit would like to computerize, is another major factor. Simply typing everything, however, is not sufficient. Record-keeping anomalies can cause inappropriate treatment.
Eventually, my mother-in-law's doctor recommended that she remain in a wheelchair, because her bones broke under the slightest pressure, and she had too many fractures to count. After she was admitted to a nursing home about a year later, the staff happily told us to our horror that they were trying to get her back on her feet. She had a recurring incurable eye infection as well which, like her mobility status, was not mentioned on the front page of her chart.
Once, we requested a print-out of her medication history. What we received was neatly typed, but was nonetheless a nightmare to decipher. Ever optimistic fools that we are, we expected to find the information in date order – either past to present or vice-versa. We didn't. Perhaps someone arranged the pages wrong? No, the dates went forward and backward multiple times on each page.
Some failures to record doctors' orders result in what may seem like "mere" inconvenience and waste, but can be devastating to patients. While at an assisted care facility, my mother was taken several times to her eye doctor who ultimately recommended cataract surgery. The appointment was made and kept. My mother was fasting as ordered. The doctor, however, refused to do the surgery when he learned that my mother had not been taken off of coumadin as he had instructed. Mom, who was eighty-five, was crushed and confused. After all, one of the benefits of assisted care is that professionals are supposed to monitor your medications and see to it that doctors' orders are followed.
Additionally, insurees are bombarded with paperwork. Some healthcare insurance mailings, neatly and expensively printed and "explaining" the company's policies, are so full of disclaimers and poorly worded information as to befuddle even the professionals called upon to interpret them. As a retired state employee, I receive excellent supplemental coverage. The company which provides it also sells less attractive versions to the general public. The mailings I receive often apply to these other policies, causing me to phone the state employees' retirement system on many occasions for clarification. Often, they don't know the answer and have to get back to me., Sometimes, however, I get the feeling that I'm just supposed to know that this or that statement sprinkled through an otherwise accurate brochure, changes in coverage or bills for premium payments don't apply to me.
Other paperwork relating to our personal treatment also reeks of redundancy and confusion. When I had radiation therapy for breast cancer, I received a statement for each day of therapy plus a weekly summary and an overall summery – all in separate envelopes. When we have tests and procedures, we get a variety of mailings, some of which are bills and some not. Most offer no clue as to what they refer. The use of "Codes" forces people to call hospitals or insurance companies about things which should be obvious, again adding to cost.
My mother-in-law, who didn't have long-term coverage, ended up on Medicaid. The savings, which she and her husband worked a lifetime to accumulate, were spent on personal care facilities, which aren't covered by health insurance, and the majority of her nursing home care, which was not covered by Medicare or her supplemental policy.
Though we had no legal obligation to pay for her care and Medicaid was paying, we received regular bills from the nursing home. When my husband inquired about them, he was told to just throw them out. When he questioned why they didn't eliminate her name from the standard billing list in the computer, he was told that they can't do it, and "it's corporate, just ignore them."
The bills were easier to ignore than the knowledge that people all over the country are receiving similar mailings at all of our expense.
After Mom died, the nursing home returned her next Social Security check to the Social Security Administration as is legally required. Several weeks later, Mom received a letter from SSA stating that they needed to talk to her. The matter was cleared up by phone. The preparation and delivery of the letter, the phone call and the salary of the SSA employee (times how many others), however, all count as avoidable expenses in my book.
The problem of paperwork overload is not limited to the healthcare industry. Nonetheless, it is within the healthcare industry that this modern phenomenon has its most insidious and damaging affects. What do you suppose the findings would be, if an experiment were conducted gauging the affect that coping with this assault has on our productivity, confidence in the system and stress levels?
Medical Mistakes: Is Protecting Yourself Possible?
"The Report to the President on Medical Errors," published in 2000 by the Institute of Medicine (IOM) estimates that between 45,000 and 98,000 deaths occur in hospitals annually due to medical mistakes. Using the lower, most conservative number, that would make medical errors the eighth leading cause of hospital deaths – more than deaths from car accidents, breast cancer or AIDS. What would the figure be if they included deaths in nursing homes, outpatient centers, ambulatory surgery facilities, doctors' and dentists' offices and college and military health services?
Twice in our family, we have had relatives diagnosed with incurable infections after surgery. The doctors didn't see fit to inform us. Both times, we found out accidentally. Though neither ever recovered and both died in nursing homes, their death certificates list the cause of death as "congestive heart failure." In neither case was anyone actually with the person at the time of death, nor was their any postmortem exam – not that I'm recommending that. The doctors made the determination by phone. The point is that the statistics about medical mistakes, though alarming, are slanted in favor of keeping the medical profession's "dirty" little secrets from the public.
Neither of these cases resulted in any attempt by our family to file charges. I suspect that the cases which so offend the medical industry are the tip of the iceberg, since most people may never learn the truth and most who do are disinclined to go through a legal battle after the death of a loved one.
Patients are often encouraged to become well informed on matters of their own healthcare. The current structure, however, makes it difficult to do so. How do you sort out truth from fiction, choose the right doctor or hospital or confirm a diagnosis?
To learn how patients can become better advocates, there's no one better to ask than CNN's 2008 Hero of Patient Empowerment, Every Patient's Advocate Trisha Torrey. A syndicated newspaper columnist, radio host, speaker and author, Torrey, who holds a masters degree in education, is the patients' advocacy expert on About.com. Owned by The New York Times, it is one of the top ten most visited internet sites.
Torrey, who owned a marketing consultancy company focusing on marketing web development, became involved with patient advocacy after being diagnosed in 2004 by two labs with a rare, incurable cancer. She started reading everything she could find about the disease which was supposed to kill her within six months. Just before chemo was scheduled to start, she realized that she didn't have cancer at all. This was confirmed by the National Institutes of Health. Realizing that others were in similar situations, she documented what she had done and started the non-profit diagKNOWsis.org. The site has resources which teach people how to conduct their own research, read medical records and communicate effectively with their doctors. She also offers a free organization chart to help keep it all together: http://www.diagknowsis.org/
I asked Trisha Torrey to comment on the current ability of Americans to find accurate information about healthcare providers.
"Transparency of information about success rates, statistics, medical errors and other important decision-making basics," Torrey says, "is practically non-existent in the United States."
She explains that some states require hospitals to publish infection rates, but cautions that, "There is no one enforcing their laws or double checking to see how accurate that information is."
Torrey describes the private sector's attempts to provide information as, "incomplete at best, and inaccurate at worst." She also cautions against trusting online ratings sites, where patients rate their doctor/hospital experiences, though she considers them "a good idea at their heart."
"There are so many ways that information can be manipulated," she states, "that most of them can't really give an objective assessment that is usable by patients who need to make decisions."
The information provided by the health departments or licensing bureaus of most states on their websites is very basic. Patients can verify whether doctors and facilities are licensed and how long they've been in practice. Some mention if they have had to defend a lawsuit and the outcome.
"You won't find infection rates tied to any specific doctors, she cautions, "You might find an infection rate for a hospital, but it will reflect the entire hospital's record and again -- we have no way of knowing how accurate it is."
Many hospitals use statistics for marketing purposes, claiming they have the best record in the state for cardiac surgeries or the like.
"Patients are wise to look behind those statistics," Torrey counsels, "You may learn that yes, that track record is quite good for placing stents or doing a bypass -- but if you need a heart transplant or a valve replacement? Maybe not. Be sure you're-comparing surgical apples to surgical apples."
Any decision to use a specific doctor or hospital will limit other choices. Doctors can only operate in hospitals where they have admitting privileges. If your state discloses infection statistics and you choose the hospital based on that, you must use one of their doctors.
"The one piece of advice you don't see often," Torrey suggests, "is to ask the surgeon him or herself how often (or how many times) he or she has performed the exact surgery one needs."
She advises that, unless the procedure is new or experimental, you should be looking for someone who has successfully done the specific procedure hundreds or thousands of times.
Despite the limitations of the current system, Torrey does have several recommendations. She suggests patients use a variety of resources for input before making their decisions.
Even if you're not on Medicare, the information they provide can be helpful: http://www.hospitalcompare.hhs.gov/
Also, she suggests two listings of the nation's top facilities. US News and World Report has an annual assessment of hospitals. There's also a new list at: http://www.hospitalcompare.hhs.gov/
Trisha Torrey's book You Bet Your Life! The 10 Mistakes Every Patient Makes is scheduled to be released this fall.
Visit About.com's "Guide to Patient Empowerment" at: http://patients.about.com/
That's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't.
This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system.
We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year—almost $8,000 per person."
That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and those who think they are covered. Conditions flagged for refusal to insure, premium increases or for "re-evaluating" (discontinuing) coverage, which used to be limited to the most debilitating disorders, now include diabetes and asthma – two of America's fastest rising diseases.
Cutting costs, providing coverage for the uninsured and guarantying that coverage cannot be refused based on diagnosis or denied because of pre-existing conditions, are essential goals. These, however, will not be sufficient to fix the system.
By every major measure of healthcare and wellness, from infant mortality to longevity, the United States lags behind other developed nations. In 2008, the Centers for Disease Control (CDC) rated the US as 29th in infant mortality. The longest-lived people on the planet live in Andorra, San Marino, Singapore and Japan. Austria, Australia, Canada, France, Germany, Greece, Israel and Italy are just some of the countries where people live longer than the U.S. average -- seventy-eight years.
The World Health Organization conducted the first analysis of the world's health systems in 2000. They found that, although the US spends the highest portion of its gross domestic product (GDP) on healthcare, it ranks only thirty-seventh out of 191 nations. France and Italy provide the best overall healthcare. San Marino, Andorra, Malta and Singapore are right behind Italy, followed by Spain, Oman, Austria and Japan. The United Kingdom, which spends only six percent of GDP on healthcare, is eighteenth.
The problem is complicated. For one thing, profound flaws in the basic education of healthcare professionals are contributing to many medical errors, especially in diagnosing and treating elderly patients. In her article "The Patients Doctors Don't Know" (July 2, 2009, The New York Times), Dr. Rosanne M. Leipzig, a physician and professor at Mt. Sinai School of Medicine, explains that experience in geriatric care, unlike pediatrics and obstetrics, is not required for medical school graduates. This oversight persists despite the fact that physicians have long since been far more likely to have elderly patients, a situation which is increasing as the population ages.
Conditions like heart attacks and pneumonia, which present different symptoms in the elderly, are often misdiagnosed. The resulting improper treatment makes these patients more likely to need further care, escalating healthcare costs. The 2008 Institute of Medicine (IOM) report "Retooling for an Aging America" makes significant recommendations on the subject, but as Leipzig writes, "this resolution lacks teeth,".
"Medical resident training programs that receive Medicare money," Dr. Leipzig continues, "should be required to demonstrate that their trainees are competent in geriatric care."
What a concept.
After the Ink Dries: The Impact of Paperwork on Healthcare
Paperwork is another huge contributor to the healthcare problem. Handwritten prescriptions and doctor's orders cause countless adverse reactions, in addition to improper and neglected treatment. What about the cost in dollars as well as undelivered care for the time wasted when conscientious medical professionals, who realize they aren't sure what is written, stop what they are doing to find out?
Legibility is just one issue. A consequence of the enormous number of prescription drugs is that medications for different conditions have similar names. In 2005, one death in Boston was attributed to giving a huge dose of Librium to a patient instead of the prescribed Lithium. Toprol (a beta blocker prescribed for high blood pressure, chest pain and heart failure) and Topamax (used to treat epilepsy and prevent migraines) have also been confused, causing adverse reactions. Similarities in packaging for child and adult doses of certain medications have led to life-threatening situations. The most publicized of these involved the twelve-day-old twins of actor Dennis Quaid, who, in 2007, received a dose of heparin a thousand times stronger than prescribed.
Pharmacists and nurses must exercise extreme care to get it right. Nonetheless, my husband once witnessed a nurse preparing tiny cups of evening meds for her entire wing while on her cell phone. What could go wrong there?
The management of patient records, which President Obama to his credit would like to computerize, is another major factor. Simply typing everything, however, is not sufficient. Record-keeping anomalies can cause inappropriate treatment.
Eventually, my mother-in-law's doctor recommended that she remain in a wheelchair, because her bones broke under the slightest pressure, and she had too many fractures to count. After she was admitted to a nursing home about a year later, the staff happily told us to our horror that they were trying to get her back on her feet. She had a recurring incurable eye infection as well which, like her mobility status, was not mentioned on the front page of her chart.
Once, we requested a print-out of her medication history. What we received was neatly typed, but was nonetheless a nightmare to decipher. Ever optimistic fools that we are, we expected to find the information in date order – either past to present or vice-versa. We didn't. Perhaps someone arranged the pages wrong? No, the dates went forward and backward multiple times on each page.
Some failures to record doctors' orders result in what may seem like "mere" inconvenience and waste, but can be devastating to patients. While at an assisted care facility, my mother was taken several times to her eye doctor who ultimately recommended cataract surgery. The appointment was made and kept. My mother was fasting as ordered. The doctor, however, refused to do the surgery when he learned that my mother had not been taken off of coumadin as he had instructed. Mom, who was eighty-five, was crushed and confused. After all, one of the benefits of assisted care is that professionals are supposed to monitor your medications and see to it that doctors' orders are followed.
Additionally, insurees are bombarded with paperwork. Some healthcare insurance mailings, neatly and expensively printed and "explaining" the company's policies, are so full of disclaimers and poorly worded information as to befuddle even the professionals called upon to interpret them. As a retired state employee, I receive excellent supplemental coverage. The company which provides it also sells less attractive versions to the general public. The mailings I receive often apply to these other policies, causing me to phone the state employees' retirement system on many occasions for clarification. Often, they don't know the answer and have to get back to me., Sometimes, however, I get the feeling that I'm just supposed to know that this or that statement sprinkled through an otherwise accurate brochure, changes in coverage or bills for premium payments don't apply to me.
Other paperwork relating to our personal treatment also reeks of redundancy and confusion. When I had radiation therapy for breast cancer, I received a statement for each day of therapy plus a weekly summary and an overall summery – all in separate envelopes. When we have tests and procedures, we get a variety of mailings, some of which are bills and some not. Most offer no clue as to what they refer. The use of "Codes" forces people to call hospitals or insurance companies about things which should be obvious, again adding to cost.
My mother-in-law, who didn't have long-term coverage, ended up on Medicaid. The savings, which she and her husband worked a lifetime to accumulate, were spent on personal care facilities, which aren't covered by health insurance, and the majority of her nursing home care, which was not covered by Medicare or her supplemental policy.
Though we had no legal obligation to pay for her care and Medicaid was paying, we received regular bills from the nursing home. When my husband inquired about them, he was told to just throw them out. When he questioned why they didn't eliminate her name from the standard billing list in the computer, he was told that they can't do it, and "it's corporate, just ignore them."
The bills were easier to ignore than the knowledge that people all over the country are receiving similar mailings at all of our expense.
After Mom died, the nursing home returned her next Social Security check to the Social Security Administration as is legally required. Several weeks later, Mom received a letter from SSA stating that they needed to talk to her. The matter was cleared up by phone. The preparation and delivery of the letter, the phone call and the salary of the SSA employee (times how many others), however, all count as avoidable expenses in my book.
The problem of paperwork overload is not limited to the healthcare industry. Nonetheless, it is within the healthcare industry that this modern phenomenon has its most insidious and damaging affects. What do you suppose the findings would be, if an experiment were conducted gauging the affect that coping with this assault has on our productivity, confidence in the system and stress levels?
Medical Mistakes: Is Protecting Yourself Possible?
"The Report to the President on Medical Errors," published in 2000 by the Institute of Medicine (IOM) estimates that between 45,000 and 98,000 deaths occur in hospitals annually due to medical mistakes. Using the lower, most conservative number, that would make medical errors the eighth leading cause of hospital deaths – more than deaths from car accidents, breast cancer or AIDS. What would the figure be if they included deaths in nursing homes, outpatient centers, ambulatory surgery facilities, doctors' and dentists' offices and college and military health services?
Twice in our family, we have had relatives diagnosed with incurable infections after surgery. The doctors didn't see fit to inform us. Both times, we found out accidentally. Though neither ever recovered and both died in nursing homes, their death certificates list the cause of death as "congestive heart failure." In neither case was anyone actually with the person at the time of death, nor was their any postmortem exam – not that I'm recommending that. The doctors made the determination by phone. The point is that the statistics about medical mistakes, though alarming, are slanted in favor of keeping the medical profession's "dirty" little secrets from the public.
Neither of these cases resulted in any attempt by our family to file charges. I suspect that the cases which so offend the medical industry are the tip of the iceberg, since most people may never learn the truth and most who do are disinclined to go through a legal battle after the death of a loved one.
Patients are often encouraged to become well informed on matters of their own healthcare. The current structure, however, makes it difficult to do so. How do you sort out truth from fiction, choose the right doctor or hospital or confirm a diagnosis?
To learn how patients can become better advocates, there's no one better to ask than CNN's 2008 Hero of Patient Empowerment, Every Patient's Advocate Trisha Torrey. A syndicated newspaper columnist, radio host, speaker and author, Torrey, who holds a masters degree in education, is the patients' advocacy expert on About.com. Owned by The New York Times, it is one of the top ten most visited internet sites.
Torrey, who owned a marketing consultancy company focusing on marketing web development, became involved with patient advocacy after being diagnosed in 2004 by two labs with a rare, incurable cancer. She started reading everything she could find about the disease which was supposed to kill her within six months. Just before chemo was scheduled to start, she realized that she didn't have cancer at all. This was confirmed by the National Institutes of Health. Realizing that others were in similar situations, she documented what she had done and started the non-profit diagKNOWsis.org. The site has resources which teach people how to conduct their own research, read medical records and communicate effectively with their doctors. She also offers a free organization chart to help keep it all together: http://www.diagknowsis.org/
I asked Trisha Torrey to comment on the current ability of Americans to find accurate information about healthcare providers.
"Transparency of information about success rates, statistics, medical errors and other important decision-making basics," Torrey says, "is practically non-existent in the United States."
She explains that some states require hospitals to publish infection rates, but cautions that, "There is no one enforcing their laws or double checking to see how accurate that information is."
Torrey describes the private sector's attempts to provide information as, "incomplete at best, and inaccurate at worst." She also cautions against trusting online ratings sites, where patients rate their doctor/hospital experiences, though she considers them "a good idea at their heart."
"There are so many ways that information can be manipulated," she states, "that most of them can't really give an objective assessment that is usable by patients who need to make decisions."
The information provided by the health departments or licensing bureaus of most states on their websites is very basic. Patients can verify whether doctors and facilities are licensed and how long they've been in practice. Some mention if they have had to defend a lawsuit and the outcome.
"You won't find infection rates tied to any specific doctors, she cautions, "You might find an infection rate for a hospital, but it will reflect the entire hospital's record and again -- we have no way of knowing how accurate it is."
Many hospitals use statistics for marketing purposes, claiming they have the best record in the state for cardiac surgeries or the like.
"Patients are wise to look behind those statistics," Torrey counsels, "You may learn that yes, that track record is quite good for placing stents or doing a bypass -- but if you need a heart transplant or a valve replacement? Maybe not. Be sure you're-comparing surgical apples to surgical apples."
Any decision to use a specific doctor or hospital will limit other choices. Doctors can only operate in hospitals where they have admitting privileges. If your state discloses infection statistics and you choose the hospital based on that, you must use one of their doctors.
"The one piece of advice you don't see often," Torrey suggests, "is to ask the surgeon him or herself how often (or how many times) he or she has performed the exact surgery one needs."
She advises that, unless the procedure is new or experimental, you should be looking for someone who has successfully done the specific procedure hundreds or thousands of times.
Despite the limitations of the current system, Torrey does have several recommendations. She suggests patients use a variety of resources for input before making their decisions.
Even if you're not on Medicare, the information they provide can be helpful: http://www.hospitalcompare.hhs.gov/
Also, she suggests two listings of the nation's top facilities. US News and World Report has an annual assessment of hospitals. There's also a new list at: http://www.hospitalcompare.hhs.gov/
Trisha Torrey's book You Bet Your Life! The 10 Mistakes Every Patient Makes is scheduled to be released this fall.
Visit About.com's "Guide to Patient Empowerment" at: http://patients.about.com/
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